[by Tamara Sellman RPSGT CCSH for Advanced Cardiovascular Sleep Disorders Center]
Sleeping well may be one of the biggest challenges for most people. But identifying the root cause of poor sleep is even more elusive.
- Could it be caused by poor sleep hygiene?
- Is it the result of a health condition you know about?
- Might medications be part of the problem? What about menstrual cycles, stress, or allergies?
Or maybe you have an actual sleep disorder.
It's ill advised to diagnose yourself in any event. Your best bet is to consult a primary care or family physician first with your sleep complaints, then follow the protocols they provide you.
Sometimes sleep problems can be laid to rest (pun intended) with some simple advice for improving bedtime habits, adjusting medication doses or timing, or addressing preexisting health problems, like obesity or diabetes.
But when a general practitioner can't help you get the sleep you need, a board-certified sleep physician can be called into the discussion. From there, you may expect one or more of the following to take place:
- a sleep health assessment
- a home-based sleep study, or an overnight lab study at a sleep clinic
- a visit to another specialist, such as a neurologist, a therapeutic psychiatrist, or an ear/nose/throat physician
Whatever else happens, you might learn that you have a previously undetected sleep disorder. Which may seem like bad news... but the good news is, all sleep disorders have effective treatments in place to help you find the relief you need.
Sleep Disorders, At A Glance
If you're diagnosed with a sleep disorder, it will be among one of the following.
Most people have bouts of sleeplessness at some time in their lives. Insomnia describes problems with falling asleep or staying asleep. If you also sleep well at the beginning of the night but awaken far too early in the morning and can't get back to sleep, that can also be defined as insomnia.
There are three kinds to consider:
- short-term (or acute) insomnia
- chronic insomnia (lasting more than 3 nights a week over a period of 3 months)
- other insomnia (when insomnia symptoms don't meet criteria for the other 2 kinds)
SLEEP-RELATED BREATHING DISORDERS
These include all forms of breathing problems that occur during sleep: sleep apnea, hypoventilation, and variations of sleep-disordered breathing. Please note that, in all sleep-related breathing disorders, the use of medications (for sleep, for treatment, or for recreation) can severely exacerbate problems with breathing while asleep.
There are 3 main categories of sleep apnea syndromes:
- Central sleep apnea (CSA) includes 8 different kinds of sleep-breathing problems which occur due to a dysfunction in brain function that controls the respiratory drive during sleep.
- Obstructive sleep apnea (OSA) includes adult and pediatric versions of this mechanical breathing dysfunction caused by collapsing upper airway tissues, cranial malformation, or passages crowded by organs like the tongue or uvula.
- Mixed sleep apnea constitutes a combination of CSA and OSA and usually occurs in individuals with a host of other chronic health issues.
Hypoventilation is defined as an abnormal breathing that causes an imbalance of oxygen (not enough) and carbon dioxide (too much) in the bloodstream. It could be due to a slow breathing (or respiratory) rate, shallow breathing, or diminished lung function.
Different causes distinguish the 7 kinds sleep-related hypoventilation, from obesity to congenital issues to drug use to other medical disorders (known as comorbidities).
Isolated symptoms and normal variants
Most commonly, snoring is the culprit, not only for the person asleep, but for any bed partners, roommates or family members who must endure it.
Catathrenia is another kind of noisy and disruptive sleep in which grunting sounds take place.
For more information, read How to Find Out If You Have A Sleep Breathing Disorder.
CENTRAL DISORDERS OF HYPERSOMNOLENCE
Hypersomnolence is also referred to as hypersomnia. While insomnia ("no sleep") is a common night-time problem, hypersomnia ("too much sleep") is a common daytime problem.
Narcolepsy is a potentially disabling form of hypersomnolence that can lead to the irresistible need to sleep even after a full night's rest. It can also lead to something known as "sleep attacks," which reference a kind of symptom known as cataplexy, in which the person with narcolepsy collapses and appears to be asleep.
Other kinds of hypersomnia can be explained by medical problems, medications, psychiatric problems, or a lack of sleep known as insufficient sleep syndrome. However, sometimes it can be difficult to identify the root cause of hypersomnia, in which case it is labeled idiopathic in nature.
Finally, a rare condition known as Kleine-Levin syndrome (what some people call "Sleeping Beauty Syndrome") causes some people to sleep for extended periods over weeks, even months.
CIRCADIAN RHYTHM SLEEP-WAKE DISORDERS
This category of sleep disorders delves into dysfunctional sleeping and wakefulness based upon issue of timing. Because sleeping and wakefulness take place outside the range of normal human circadian rhythms for those with this form of sleep disorder, their lives can be severely altered.
Imagine keeping a day job when your normal body clock inspires sleep only after 3am. Or missing out on family and social activities because your brain shuts down at 5pm at night. Sleep-wake phase disorders (delayed, or DSPD, and advanced, or ASPD) describe problems with either falling asleep way too late or going to bed way too early.
Still others suffer because they don't know when sleep will come; their sleep phases are random and impossible to plan for (irregular sleep-wake rhythm disorder), or their sleep phases keep shifting so that they might sleep during normal sleeping hours one week, only to find their rhythms have flipped so that sleep only comes during the day (Non-24-hour sleep-wake rhythm disorder).
Those who work evening or overnight ("third" or "graveyard") shifts can suffer what is known as shift work disorder, which can lead to chronic health problems over time. Frequent cross-country travelers also experience jet lag disorder, which is different from ordinary jet lag because they never synchronize with a "home" time due to their ongoing travel.
Other people may experience circadian sleep-wake disorders not defined here, such as seasonal affective disorder (SAD), more commonly known as "the winter blues," which is caused by reduced natural light during the fall and winter months.
There are more than a dozen forms of parasomnia. Nearly half are related to unusual behaviors that occur in sleepers who are not in rapid-eye movement (REM) sleep, such as sleepwalking, sleep terrors, or sleep-related eating disorders.
Parasomnias that occur during REM sleep (the period we most associate with dreaming) include "acting out" one's dreams (during REM sleep) in the case of REM sleep behavior disorder. Other REM-related disorders include nightmare disorder (common among those with PTSD) and recurring sleep paralysis.
Bedwetting (also known as nocturnal enuresis) is categorized as a parasomnia. Some parasomnias are caused by medical problems or medication. More unusual parasomnias include exploding head syndrome, auditory or visual hallucinations that take place during transitions in and out of sleep, and
SLEEP-RELATED MOVEMENT DISORDERS
We shouldn't be moving about when we are asleep, but frequently we do, and that can create problems with broken or lost sleep.
More common movement disorders of sleep include restless legs syndrome (RLS, also known as Willis-Ekbom disease), nocturnal leg cramps, and sleep bruxism (the grinding of teeth or clenching of the jaw while asleep). Less well known but equally problematic is periodic limb movement disorder (PLMD), in which the legs (or, sometimes, the arms) move during sleep in rhythm patterns. Similarly, sleep-related rhythmic movement disorder describes people (especially children) who bump their heads as a form of self-soothing at night. Some movement disorders relate to seizure behavior, while others can be blamed on medical conditions or medications.
OTHER SLEEP DISORDERS
Some sleep disorders resist categorization, or present themselves as variations of other kinds of sleep disorders. The "other" category describes isolated symptoms and normal variants of sleep which don't otherwise qualify as sleep disorders.
In some cases, variations of sleeping behaviors can be unusual but not abnormal. Talking in one's sleep, for instance, is not considered a sleep disorder, but a harmless behavior that takes place during sleep. Neither is the experience of "hypnic jerks" abnormal: these are those strange falling sensations we all experience from time to time while transitioning into sleep.
What is the ICSD-3? [View in Wikipedia]
The International Classification of Sleep Disorders is sleep medicine's bible of sleep disorders. As research continues to shed light on sleep dysfunction, the ICSD is updated to reflect new knowledge.
The compendium was most recently updated in a 3rd edition (ICSD-3) in 2014 to include 60 specific diagnoses among seven major categories. It also includes an appendix that links sleep disorders that may be associated with medical and neurologic disorders.
The most recent version was also updated to reflect a better understanding of insomnia that more better corresponds with definitions of sleeplessness found in the Diagnostic and Statistical Manual (now in version 5) used by psychiatrists to identify, diagnose, and treat mental disorders.
One Final Thought
Because each case typically includes more than just the disorder itself (it might also include external environment concerns, family relationships, work schedules, and other details that are unique to you), the treatment protocol you are offered may vary greatly from the one offered to a friend, family member, neighbor or co-worker.
Are you concerned about sleep problems and suspect you might have a sleep disorder, and you live in the Auburn-Opelika region, call Advanced Cardiovasculars Sleep Disorders Center at (334) 321-3840 to find out how to secure a referred appointment to speak with one of our sleep medicine specialists.